Monday, August 24, 2009

Osteoporosis Drugs – Fact versus Fiction

You see the ads. You hear the hype.

Your doctor recommends them…What do you do?

Bisphosphonates
The drugs for osteoporosis known as bisphosphonates decrease bone resorption by inhibiting the cells that break down bone (osteoclasts). They actually bind to and become part of the bone and eventually stop bone formation.


These drugs include:

Alendronate sodium - Generic and Fosamax
Ibandronate sodium - Boniva
Isedronate sodium - Actonel
Etidronate disodium – Didronel
Pamidronate disodium - Aredia
Tiludronate disodium - Skelid
Zoledronic acid - Aclasta; Reclast

All of these drugs are related and have similar side effects. They differ mainly by how often they are taken and whether they are a pill or IV. In this article I will refer to them collectively as Bisphosphonates

Why are these drugs so popular?
· Massive marketing campaigns
· They do increase bone density readings which leads many to mistakenly believe this means better bone
· They can produce a short term decrease in the risk of fractures in a few – a point that is greatly exaggerated by proponents of these drugs
· Doctors feel the need to do something and they are largely ignoring the best solutions

Reasons not to take Osteoporosis Drugs
· If you have osteopenia they have been shown to increase the fracture risk
· If you have osteoporosis, the chances of short term benefit is remote (1/81 chance)
· Long term these drugs essentially poison & kill bones and produce many side effects – some of them very serious
· The result in weaker, more brittle bone – especially after 5 years
· There are safer, natural approaches

Most Taking These Drugs Have No Personal Benefit
The studies showing benefit for these drugs are in the first 5 years of treating osteoporosis. The reason people take these drugs is to prevent fractures; however, a 2008 review of more than 12,000 women using alendronate showed only a 1-2% absolute risk reduction in women who have already developed osteoporosis.

The majority of the prescriptions written for these drugs are for individuals who have only some bone loss called osteopenia. The Hype in the media is the message that “these medications will protect your bones.” The reality is that they actually increase fracture risk. The FIT study – the Fracture Intervention Trial showed that when these drugs are used as for osteopenia, there is an increased risk of fractures. You can read this study in the reference section at the end.

Side Effects
Bone is alive and is in a constant state of remodeling by dissolving small bits of old bone (a process known as resorption) and building new bone. This remodeling allows bone to repair itself from fractures both large and microscopic.

When the levels of our bone building hormones begin to fall in midlife, bone resorption outpaces the bone building. This results in a net loss of bone which can be milder (osteopenia) or more severe (osteoporosis). The bone builders in women include Progesterone, DHEA and Estrogen. In men Testosterone and DHEA are important bone builders.

Instead of replacing declining hormones, many physicians are recommending bisphosphonates. Is this wise? Bisphosphonates do not just slow bone resorpting osteoclast activity, they poison them and eventually stop bone production by the osteoblasts.

These compounds strongly bind to the bone and become part of it. This is very unnatural.
As the graphs below show, these drugs eventually stop the bone building process.


These drugs transform living bone into inactive – essentially dead, chemically altered skeletons. Do they work to reduce fractures? In those with osteopenia they increase the fracture risk. In those with osteoporosis they temporarily decrease the fracture risk – for about 4-5 years. However, the chance of personally benefiting during this 5 year period is very low – about 1 in 86 chance.

After 5 years on these drugs, the cumulative effect of

1)preventing the repair of micro-fractures
2) blocking bone formation and
3)adding a foreign chemical to the matrix of the bone

results in bone that looks good on the bone density machine but is actually weak, brittle and essentially dead.

The increased fractures associated with these drugs may occur suddenly – even without trauma.

In addition to sudden fractures one can develop bone death in the jaw bone – especially after dental procedures and joint and muscle pain. In 2008 an FDA alert was issued warning of sudden bone and muscle pain with these drugs that can persist after the drugs are stopped.

To Summarize - Side Effects of Bisphosphonates include:
· Increased risk of fractures with osteopenia
· Increased fracture risk with osteoporosis after 5 years
· Irritation and ulcers of the esophagus
· Fractures of the femur (often without any trauma – they just snap)
· Low calcium in the blood
· Jaw bone decay (osteonecrosis) – especially after having a tooth removed
· Atrial fibrillation (increases risk 1.86 times) – this can lead to stroke/death
· Joint, bone, and muscle pain (potentially irreversibly) may occur within days, months, or years after starting a bisphosphonate

Bottom line: These drugs have serious side effects and poor effectiveness – Avoid Them

These drugs are most often used for osteopenia where they can actually increase fracture risk. Their long term effects in all who use the drugs is to possibly permanently impair the ability of the bone to grow as well as to remodel and repair small micro-fractures. The net result produces brittle, near dead bone. The bones appear to be able to recover partially when these drugs are stopped but some effects are permanent.

Safer, natural approaches
Why would you want to take a drug that actually blocks bone formation when there are actually natural ways of increasing bone production?

Avoid
· Soda/soft drinks (the acid in them weakens bone)
· Smoking
· Excessive caffeine
· Excessive grain intake
· Milk? There is actually an inverse relationship between how much a society drinks milk and bone density


Do

· Optimize Vitamin D
· Daily eat 5-9 Servings of Fruit and Vegetables, drink Vegetable Juice, take Fruit/Vegetable capsules (http://www.naturalwellnesschoices.com/ to order)
· Eat green leafy vegetables like spinach and collard greens
· Optimize Hormones: DHEA, Progesterone, Estrogen and Testosterone
· Exercise – weight bearing exercise
· Get natural sunlight
· Supplemental calcium, magnesium
· Vitamin K2 (about 100 mcg a day)
-Strontium - 680 mg a day can significantly build bone


In many cases doctors may not be aware of the negative effects of these medications. I trust this information will help you make better decisions about your health care. Some references you may find useful are below.

Selected References
Effect of Alendronate on Risk of Fracture in Women With Low Bone Density but Without Vertebral Fractures Results From the Fracture Intervention Trial
http://jama.ama-assn.org/cgi/content/full/280/24/2077

Dr. Susan M. Ott at the University of Washington, Seattle wrote an article entitled Long-Term Safety of Bisphosphonates which was published in The Journal of Clinical Endocrinology & Metabolism (Vol. 90, No. 3 1897-1899). You can read the text at http://jcem.endojournals.org/cgi/content/full/90/3/1897.

Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst. Rev., 23 http://www.ncbi.nlm.nih.gov/pubmed/18253985

An emerging pattern of subtrochanteric stress fractures: A long-term complication of alendronate therapy? Injury, 39 (2), 224–231. http://www.ncbi.nlm.nih.gov/pubmed/18222447

Drugs to build bones may weaken them. New York Times, July 15, 2008
http://www.nytimes.com/2008/07/15/health/15well.html?partner=rssnyt&emc=rss

Alonso–Coello, P., et al. 2008. Analysis. Drugs for pre-osteoporosis: Prevention or disease mongering? BMJ, 336 (7636), 126–129. http://www.bmj.com/cgi/content/full/336/7636/126
Carmona, R. 2004. Bone health and osteoporosis. A report of the Surgeon General. http://www.surgeongeneral.gov/library/bonehealth/content.html

Brown, S. 2008. Vitamin D and fracture reduction: An evaluation of the existing research. Alt. Med. Rev., 13 (1), 21–33. http://www.thorne.com/altmedrev/.fulltext/13/1/21.pdf